TREATMENT OF HEPATOBLASTOMA - LESS EXTENSIVE HEPATECTOMY AFTER EFFECTIVE PREOPERATIVE CHEMOTHERAPY WITH CISPLATIN AND ADRIAMYCIN

Background. Although the prognosis of hepatoblastoma was improved by t he introduction of cisplatin and doxorubicin (Adriamycin) for adjuvant chemotherapy extensive hepatectomy continues to be the usual practice . We retrospectively reviewed our recent experience with hepatoblastom a to determine whether the new modality of intensive chemotherapy coul d change the resectability extent of hepatectomy, operative complicati ons, and prognosis. Methods. The clinical features of 15 children with hepatoblastoma treated between 1985 and 1995 were reviewed. Intensive chemotherapy was added before surgical resection not only when a tumo r was unresectable but also when it was large enough to increase the r isk of operative morbidity. Results. There was 100% resectability and the overall mortality rate was only 6.7%. Fourteen patients have been free of disease for 2 to 12 years. Preoperative chemotherapy enabled r esection of six previously unresectable hepatoblastomas. Moreover, hep atic resection tended to be less invasive in several patients whose tu mors had been much reduced after preoperative chemotherapy. Intraopera tive and post-operative complications were minimal, with a short opera tive time and small amount of blood loss, especially in the group with delayed primary operation. Conclusions. The preoperative administrati on of cisplatin and Adriamycin reduced the tumor size so that a safe h epatectomy could be performed with less blood loss and minimal technic al complications. Unnecessary sacrifice of the normal hepatic tissue w as avoided by performing the less extensive hepatectomy.